Lecture 15: Psychological treatment in sz – Part ii Flashcards
What were the types of treatments covered in class?
- Individual cognitive and behavioral therapy
- Family interventions
- Neuropsychological and cognitive rehabilitation
- Social skills and related training
- Treatment for comorbid disorders
In the chapter on family interventions, we discussed that “Studies in the 60s and 70s revealed that people with SZ who lived in environments high in ______________showed more frequent relapse”
“expressed emotion”
What is expressed emotion?
- Critical comments
- Hostility
- Emotional over-involvement
“Expressed emotions” can be perceived as something ________ by people with SZ
negative
“Expressed emotions” can be seen as part of a _______________
normal reaction to having a family member with a severe mental illness
Families may also have incorrect expectations about________________
how much the person with SZ, is going to be able to control their symptoms.
Most of family interventions are CBT or _________
psycho-eduction based
Family interventions involve assessment and _______________
identification of problems
Explain what psychoeducation entails for families of a person with SZ
1) Part of psychoeducation can entail covering the causes of the disorder because people often do not understand the causes, they might blame themselves or the person.
2) They can feel that others don’t understand the causes of the disorder and blame them. It can also be difficult to respect the autonomy of the person with SZ.
3) Whenever possible, the goal is to preserve the privacy and power of making decisions.
4) It also covers the outcome of the disorder, the type of care they may need, the ressources available and guidance on how to deal with stigma.
What are the three components covered in a problem-solving focused family intervention?
1) Problem-solving around specific issues, especially medication compliance
2) Identification of symptoms of relapse
3) Strategies in times of increased symptoms
In a Problem-solving focused family intervention, what would a session including the person with SZ entail?
Discussion of family concerns, problems
In a Problem-solving focused family intervention, what would a session with the family alone entail?
- Allows different forms of education
- Allows family members to express concerns, seek support without fear of the reaction of the person with SZ
- Allows family to express sadness, grief
What are the benefits with family treatments?
- Reduce relapse rates
- Reduce hospitalizations and length of hospitalization
- Improve compliance with medications
And most importantly:
- Relatively low-cost (you dont’t necessarily need a large number of session),
- has concrete effects,
- offer support for families (reduce the burden of dealing with a family member with a mental illness, - - can reduce stigma
Why would cognitive remediation be part of the treatment for SZ?
- Medications are not very effective for cognitive symptoms (deficits in memory and executive functions).
- Those deficits are important problem for their long-term outcome.
- Cognitive remediation tries to answer the question “Are there techniques that can improve or support better cognitive function?”
What is “Neuropsychological therapy”?
- (Another term for Cognitive remediation)
- Interventions or exercises designed to strengthen or support cognitive function
- focus on attention, executive function and memory
What are the types of intervention in “Neuropsychological therapy” (i.e Cognitive remediation)?
- Direct task practice
- Attention-shaping
- Real-world tasks
Give examples of Direct task practice
- Computerized cognitive training (CPT),
- card or word sorting tasks,
- story recall,
- interpreting social situations,
- problem solving
Attention-shaping involves using____________to shape behaviors
Using continuous feedback and reward to shape behaviors
Real-world tasks involve _________
Planning activities, making decisions
Is Cognitive remediation effective?
Effectiveness is uncertain
Why is the effectiveness of cognitive remediation uncertain?
- What is learned does not always translate to real life (not ecologically valid)
What were the results of the Computerized cognitive training (reeder, 2017) study?
- Training on a range of basic and “real-world” tasks
- Guided by a therapist (often they are students in psychology program - low cost)
- 93 people with SZ:
½ treatment as usual,
½ treatment as usual + cognitive training - 3x per week, 1 hour, 12 weeks, in person
- Baseline, post-training (after 12 weeks), 26 week follow-up (12-14 weeks)
- Testing on standard cognitive tasks:
Visual spatial memory (reproduce an abstract drawing)
Executive function (WCST)
-85% of people completed the training
Improvements visual-spatial memory and executive function post treatment
-Gains smaller at follow-up
-Better executive function related to greater engagement in structured activities (school, work, day programs) - and lower positive symptom scores
-Some positive effects, but short term
What are the skills that are tested in Computerized cognitive training task “image copy” used in the (reeder, 2017) study?
Hint: You simply have to place shapes into a blank square to copy the image given to you.
- Visual-spatial skills;
- selective attention;
- hand-eye coordination
What are skills that are tested in the CPT “where am I”? used in the (reeder, 2017) study.
Hint: You are giving an image and you have to locate that image on a map.
Visual-spatial skills;
visual memory;
abstract spatial skills;
reasoning
